The Ischemic Disease: A Joke Where There's Nothing to Be Gained

Abstract 5198

This study explored the hypothesis that the ischemic disease (ID) is associated with systemic alterations of the blood coagulation system: platelet activation (sCD40L: determined by ELISA) and release of various proteins (CRP: determined by nephelometry, IL-6: determined by ELISA).

Plasma concentration of these factors were higher in patients with ischemic disease: sCD40L (ID: 724. 2 +/− 58. 4 vs controls 212 +/− 8. 6 pg/ml; p<0001), CRP (ID: 5. 76+/−1. 8 vs controls 2. 54 +/− 0. 3g/l; p<001), IL-6 (ID: 6. 36 +/− 1. 32 vs controls 2. 02 +/− 064 pg/ml; p<001).

Platelet activation predicts the risk of ischemic events, in fact CD40L binds and activates alfa IIb/beta 3, and increases PMC (platelet – monocyte complexes), and PDMP (platelet derived microparticle), it also promotes the release of several chemokines (FP4, RANTES, CxCL, ENA 78, NAP-2) that may play an important role in plaque destabilization; high levels of CD40L predict cardiovascular risk of death or myocardial infarction, or stroke within 8 to 12 month in patients with asyntomatic low grade stenosis (carotid or coronary).

Several data suggest that CRP has a prognostic value in patients with negative troponin and it is predictive for the development of CAD and refractory ischemic disease, plaque destabilization, and future adverse events, or for the development of severe disease.

IL-6 was strongly associated with markers of inflammation (CRP, fibrinogen, white cells count), plasma viscosity, elevated markers of coagulation (fibrin, D-Dimer, FVIII, FIX); moreover IL-6 is associated with insulin resistance, and its levels are high in metabolic syndrome; it is significantly correlated with age, BMI, white cell count; IL-6 increases dendritic platelet forms and acts synergistically with thrombopoietin and stem-cell factor in stimulating megakaryocytopoiesis.

Although it has been controversial, IL-6, PCR, and CD40L appear now to be very promising for quantifying the degree of ischemic disease and to monitor or to identify the efficacy and the response to the therapy.